05-0380 (RR)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) .777-701-2
78-4.95 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA .92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 05-00000380 Date 2/03/0.5
Property Address . . 80635 CHERRY HILLS
APN: 775-132-006- - -
.Application description . . . RE -ROOF
Property Zoning . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 5112
Owner Contractor
SUNRISE DESERT PARTNERS EMERALD ROOFING INC
G KELLEY P.O. BOX 1963.
76375 COUNTRY CLUB DR PALM DESERT CA 92261
PALM DESERT CA. 92121.1
WCC: STOWE INS
WC: 00063910805 01/01/06
CSLB: 770940 11/30/05
CCC: C39
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Permit . . . . .RE -ROOF
Additional desc .
Permit Fee 30.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per
BASE FEE
--------------------------------------------
Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM ROOM
SYSTEM.
Fee summary Charged. Paid
Permit Fee'Total 30.00 .00
Plan Check Total .00 .00
Grand Total 30.00 .00
FEB 0 4 1005 II Ull
.00
.010
00
ension
30.00
30.00
.00
30.00
P.O. Box 1504 • VOICE (760) 777-7012
78-49:5 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY .DEPARTMENT
Application Number: Os' 390 Date:
Applicant:
Applicant's Mailing Address:'
Architect or Engineer:
Architect or Engineer's Address:
Al/ �T
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed uMen,,
rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the -Business and Professionals
Co , and my License is I'� full force,and effect.
ense Glass C 5�( No. i 9
to� ->✓ Contracop
OWNER -BUILDER IECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county'that requires a permit to construct, alter; improve, demolish, orrepair any structure,prior to Its issuance, also requires the applicant for the permit to file a signed
statement that he orshe is licensed, pursuant to the provisions of the Contractors' State License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the. Business•
and Professions Code) or that he or. she is exempt therefrom and the.basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than:five hundred dollars ($500).): .
U I, as owner of the.property, or my employees with wages as their sole compensafion, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees; provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he orshe did not'butld or improve for the purpose of sate.).
U l; as owner of the property, am exclusivelycontracting Lwith licensed contractors to construct the, project (Sec: 7044, Business'and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and.who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B:& P:C. for this reason
WORKERS' COMPENSATION DECLARATION
,I hereby affirm under penalty of perjury one of the following declarations:
— I have and will maintain:a certificate of consent to selfansure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued:.
I have:and.will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the worts for which this permit is
��,��ttsssued. My wo ms' comp nsation.insurance cartier,arfd policy number are:
Cartier, mss/ A'Te f"xs _Policy Numbe(/
_ I certify that, in the performance of the work for which this permit Is issued, I shall not employ any person,in any manner so,as to become subject4o the workers'
compensation laws of California, and.agree that, if I should become subject -to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE:IS UNLAWFUL„AND:SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND.
CIVIL FINES UP TO ONE'HUNDR. ED THOUSAND DOLLARS ($100,000); IN'ADDITIONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there//ii►s 30
`a construction lending agency for the performance of the work for whicKthis,permitis issued (Sec. 97, Civ. C.).
Lender's Name .4
Lender's Address
APPLICANT. ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building `and Safety'for a permit subject to the conditions and restrictions set forth on this application.
1.. Each person,uponwhose behalf this application is made, each person at whose requas(and'for whoselbenefit work1s performed under or pursuant to any permit
issued•as,a result of this application, the owner, and thwapplicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission, related to the work being performed under or following, issuance of this permit.
2. Any permit issued as a result of this application becomes ,nuil and void if work isnot commenced within'180 days from date of issuance ofsuch permit; or
cessation of work for 180 days will subject permit to.cancellation.
I certify, that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and.state laws relating to building
cons cion; aand hereby authorize representatives of this cou to enter upon the above-mentioned property for inspection,purposes.
Date2 y01 (Applicant or AgeM� – �1